Internet Websites for Chest Pain Symptoms Demonstrate Highly Variable Content and Quality

Abstract

Objective: Chest pain is a common symptom with causes that range from benign to serious. We assess the content and quality of websites about chest pain symptoms that describe its causes and when to seek care. Methods: We used five search engines (Google, Bing, Yahoo, Ask, AOL) using the term “chest pain” and assessed the first 30 websites that resulted from each search. We excluded websites that were diagnosis-driven, intended for physicians, patient blogs, advertisements, news, or videos. For included websites, we assessed for the presence of content potentially useful to patients with chest pain symptoms; website quality with three instruments (DISCERN, HONcode, and JAMA benchmark criteria); readability using four validated scores, accessibility, usability, and reliability using the LIDA instrument; and popularity using the Alexa tool. Results: In 27 included websites, 96 and 81% mentioned cardiac and noncardiac causes of chest pain, respectively, while 85% described when to seek emergency care. Only 51% of websites mentioned potential tests that might be used to diagnose symptoms, 22% described potential treatments, and 11% mentioned consequences if treatment is delayed or avoided. The median website DISCERN score was 23 (interquartile range [IQR] = 18–32) out of a possible 45 points, which can be interpreted as low to medium quality. A total of 44% of websites had HONcode certification, and only 11% fulfilled all four JAMA benchmark criteria. Average reading scores demonstrated that half of websites were above the eighth to ninth grade reading level. With LIDA, the average scores were “medium” for accessibility at 83% and usability at 59% and “low” for reliability at 43%. Conclusions: Many websites that provide health information for patients about chest pain symptoms are not reliable. There is highly variable content and quality, and the average website is difficult to read for patients with low health literacy.